Psychopathology - What is Dysthymic Disorder?

By:  Kimberly Swanson, M.S. – Psy, CNA

Dysthymic Disorder is a low level form of depression that occurs more days than not for at least one year in kids and teens and at least two years in adults (APA), 2013).   The level and range of diagnosable disturbances is based on the clinicians’ judgement and expertise within the field of psychiatry and psychology (Butcher, Mineka, Hooley, 2013).    Patients who are diagnosed with dysthymic disorder must have at least two of the six additional symptoms that is often times found in depression (e.g. presence of depression - loss of appetite/overeating, loss of energy/tired, etc.); there are additional criterion found under persistent Depressive Disorders (Dysthymia) within the APA’s DSM-5 (APA, 3013).

Niculescu and Akisal (2001) suggested that dysthymia should be split into 2 subcategories:  anxious dysthymia and anergic dysthymia.  They defined these sub-categories of patients with anxious dysthymia as having defined symptoms of low self-esteem, restlessness, and being sensitive to interpersonal rejection (Niculescu and Akisal, 2001).  It is also categorized that these patients tend to seek assistance and are most likely to make less lethal suicide attempts, and do better with certain medications (e.g. selective serotonin reuptake inhibitors (SSRIs)).  Sometimes these patients have problems with substance abuse; the following are the drugs that tend to be these patients drugs of choice:  alcohol, marijuana, opiates, benzodiazepines, and etc. (Niculescu and Akisal, 2001).

Dysthymia occurs quite frequently, which can occur within the general public’s life span of 2.5 and 6 percent (Kessler et al., 1994; Kessler, Berglund, Demier et al., 2005).  The normal time frame for dysthymia is 4 to 5 years but it can last as long as 20 years or more (Keller et al., 1997; Klein et al., 2006). Chronic stress may be a contributing factor to the increased severity of the symptoms over 7.5 years follow-up over a certain period of time (Dougherty et al., 2004).  A 10 year longitudinal study was conducted with 97 participants with early-onset dysthymia; it was found that 74% recovered within 10 years, but  among those who have recovered, 71% relapsed, which occurred within 3 years of following up with their doctor (Klein et al. 2006; Klein, 2010).

References

American Psychiatric Association (APA).  (2013). Diagnostic and statistical manual of mental disorders, 5^th ed. (DSM-5).  Arlington: American Psychiatric Association (APA).
  

Butcher, J.N., Mineka, S., Hooley, J.M.  (2013). Abnormal Psychology, 15^th ed.  Upper Saddle River:  Pearson Education, Inc.   

Dougherty, L.R., Klein, D.N., Davila, J.  (2004). A growth curve analysis of the course of dysthymic disorder:  The effects of chronic stress and moderation by adverse parent-child relationships and family history.   Journal of Consulting and Clinical Psychology, 72(6), 1012-1021.

Keller, M.B., Hirschfeld, R. M.A., & Hanks, D.  (1997). Double depression:  A distinctive subtype of unipolar depression.  Journal of Affective Disorders, 45(1-2), 65-73.

Klein, D.N.  (2010). Chronic depression:  Diagnosis and classification.  Current Directions in Psychological Science, 19(2), 96-100.

Klein, D.N., Shankman, S.A., & Rose, S.  (2006). Ten-year prospective follow-up study of the naturalistic course of dysthymic disorder and double depression.  American Journal of Psychiatry, 163(5), 872-680.

Kessler, R.C., Berglund, P., Demler, O., Jin, R., & Walters, E.E.  (2005). Lifetime prevalence and age-of-onset distribution of DSM-IV disorders in the National Comorbidity Survey Replication.  Archives of General Psychiatry, 62, 593-602.

Kessler, R.C., McGonagle, K.A. Zhao, S., Nelson, C.B., Hughes, M., Eshleman, S., Wittchen, H.U., & Kendler, K.S. (1994).  Lifetime and 12 month prevalence of DSM-III-R psychiatric disorders in the United States:  Results from the National Comorbid Survey. Archives of General Psychiatry, 51, 8-19.

Niculescu, A.B. 3rd, Akiskal, H.S. (2001).  Proposed endophenotypes of dysthymia: evolutionary, clinical and pharmacogenomics considerations. Molecular Psychiatry, 6(4):363-6.

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